Biventricular pacing (BiVP) is an established treatment for reducing morbidity and mortality in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). (1) It works by reducing ventricular dyssynchrony. However, approximately one third of patients are non-responders to BiVP, particularly those with non-LBBB morphology or QRS complex duration <150ms. Procedural factors also impact the success rate of BiVP (Figure 1). Thus, alternative pacing modalities are being explored. Conduction system pacing (CSP) is being increasingly utilised as an option for those with a bradycardia pacing indication to prevent ventricular dyssynchrony and the resulting decline in cardiac function. It is also being investigated as a first-line alternative to BiVP in HFrEF and LBBB.